[thenaturalist]

Hey there, M33, got diagnosed adult with late 31, so take what I say with a grain of salt.

I have immediately had access to both medication as well as ADHD focussed psychotherapy.

ADHD is the best treatable neurological condition of all with medication and if you can have access to where you live, it's the first route I'd try to access.

Once you have access to meds, nobody can require you to take them as prescribed to keep access, but in my experience, having access is invaluable.

I do not take meds extremely regularly, albeit my daily life as a software developer is much less rigid than it was during my school years.

I won't be needing meds on days where I know for example I have few or no meetings and can uninterruptedly work on a task I enjoy.

And I don't stress on days which I know are fuller or which require more work which I'd typically find rather boring.

That brings me to the second most important point: Finishing school, getting a degree etc. are for me personally very important still.

What I really wish I'd understood earlier is that I'd have rid myself on societal definitions of "success" and just focussed on my strengths.

For me and others I've met with ADHD, reinforcing strengths through receiving motivating rewards is THE system that works.

If it is enjoyable, ADHDers excel at given tasks far beyond what I've seen other people do. We're maximizers for that positive neurotransmitter reward.

Trying to make something unfun fun with (the threat of) discipline just leads to minimizing effort for task achieval.

[hirvi74]

> ADHD focussed psychotherapy

How does anyone even find this? I find there is a lot of signal vs. noise in this realm of care. What I mean, many professionals list that they treat ADHD, when it's clearly apparent they only list that for marketing purposes. The actual care provided is either antithetical or completely unhelpful -- at least for me.

For example, of the many psychotherapist I have seen, I would often be given advice to make a schedule or a To-Do list, which let's be honest, is common fucking sense, and things I already did/still do.

If I were perhaps struggling to do something, the advice given would be something like, "Well, you just have to get it done." Wow, can't believe one needs a masters degree for that sophisticated level of wisdom. . .

[thenaturalist]

I live in Berlin, and the therapist I found was experienced, i.e. very familiar with common patterns and psychological problems (long term depression caused by adverse life effects, masking, rejection sensitivity, executive dysfunction) in late diagnosed adults.

Working with that person was invaluable for me.

That said, I met them through a personal referral of another ADHD friend and have met several other psychologists before in life with whom I never clicked.

Online services should make finding a good therapist easier accessible than ever before.

All as I can say is if it doesn't feel right, it isn't. No biggie. Keep looking and seek out another person.

You'll know if you found someone with whom it works cause there'll be clear progress early on.

[trod1234]

Did you mean to say there is a high noise floor with little signal?

A lot of spectrum disorder diagnoses are misdiagnoses for other (medical) things. The diagnoses are often used as a catchall when no one can figure it out.

For example, chronic heavy metal poisoning mimicks ADHD or ADD diagnoses, blood tests alone are useless because its bound to tissue very quickly after exposure (and bioaccumulates unless a chelator is taken). Toxicity for a number of other substances also presents similarly to these diagnoses (flouride, pfas, microplastics).

[thenaturalist]

I fail to see how your recurrent relativization of the existence of ADHD has anything to do with effective psychotherapist treatment of clear symptoms.

Also, do you have reliable sources for this poisoning hypothesis?

[trod1234]

Symptoms don't mean what you seem to think they mean.

Medical issues related to toxic exposure are medical issues, not something that can be resolved by psychotherapy.

See my other post on how to find those reliable sources, or just ask your doctor if this ever happens.

[thenaturalist]

Syptoms in the context of ADHD mean exactly what I think they mean.

ADHD is irreversible, it's not something that can be reversed or goes away on its own.

There is literature on a link between fetal heavy metal exposure and ADHD development.

I can't find anything on neurotoxins "mimicking" ADHD.

Again, by the very biological definition of what happens in a brain on ADHD, this is not reversible. It's chronic.

Sources:

1: https://my.clevelandclinic.org/health/diseases/neurotoxicity

2: https://pubmed.ncbi.nlm.nih.gov/36972880/

[trod1234]

You clearly don't know what you are talking about, and you lack the appropriate rigor needed for a proper discussion. Best of luck to you.

[jdsnape]

> For me and others I've met with ADHD, reinforcing strengths through receiving motivating rewards is THE system that works.

Do you have any specific examples of what that could look like? I have tasks I’m motivated to do, but introducing rewards for ones that I’m not motivated for always feels artificial

[doble-io]

Background: I studied psychology and I have very close cases of AD(H)D.

Psychotherapy sometimes feels artificial since if what works would feel natural or obvious, well... we wouldn't need therapy, which is a handcrafted intervention (n=1). This is *really* important to remember while you are trying to improve/do therapy. More on this later [1].

A better mental model for reward-based interventions is to think about your inner "reptile brain" as a weighted graph that connects things (stimuli) with emotions and behaviors. Those connections are mostly learned throughout your life (and therefore "artificial"). And your brain is trying to find the happiest (and laziest) path in this graph.

A very motivated person tends to have a great graph that connects stimuli like "answering emails at 9:00 with music" to "happiness" or "hitting the gym" with "muscle soreness" and with "happiness with realization" and "tasting the morning coffee."

If your lazy, hedonistic, dopamine-maximizing brain does not have a path from the behaviors you want to create (e.g., answering emails) to something pleasant, it will be hard to make that a habit.

In a very explicit way, this sometimes looks like a point system. But don't think about the points. You have two very important tasks:

1. Find your "natural" rewards: coffee, watching TV shows, going for a walk, whatever you want to do, sex. And don't forget about internal rewards: self-respect, pride, nice words for yourself. Add to the mix social rewards: share your achievements... Each person is more sensitive to a different set of rewards. Find yours and pick the ones that make sense for your life context.

2. Make those rewards contingent on your goals. For example, I try to answer important emails first thing in the morning, especially those I want to avoid, and after that I go out for a small walk or have some tea.

Over time, you will internalize that conditioned (artificial) emotion for tasks that before felt horrible. Like many are able to feel nice when they have muscle soreness, because it was conditioned over time to something nice: social reward, internal/verbal rewards, techno music, whatever.

Don't forget to be nice to yourself, start simple with small goals, forgive yourself if you don't hit every goal at the beginning.

[1] Understanding this helps a lot in therapy or "self-intervention" because if you don't understand basic behavioral intervention and why it works, sometimes the intervention itself seems childish or stupid, and that hurts the efficacy. There is a huge body of research that shows that if the patient understands the therapy and has a mental model of it, it works like magic because we change from "I am doing stupid things because my therapist is saying them" to "I am nailing this, what a behavioral change I am making. That's great—in a few weeks I will be able to do X."